Investigating the Controversial Effects of Safety Behaviors in Anxiety Disorder Treatment. Exposure with Response Prevention versus Exposure plus Safety Behaviors and the Role of Commitment to Continue.

Abstract

Background and objectives: Traditionally the practice of safety behaviors by clients in in vivo exposure has widely been regarded as impeding treatment. This view has been challenged by Rachman, Radomsky, Shafran and Zysk (2011). Healthy participants repeatedly touched a contaminant in two sessions, in which half of the participants engaged in safety behavior (cleaning hands) while the other half did not. It was found that scores of contamination, fear, danger and disgust decreased in both sessions, and the effects were not impeded by safety behavior. For contamination, safety behaviors even had beneficial effects. This finding was critically replicated by Van den Hout, Engelhard, Toffolo and Van Uijen (2011), who obtained the same results. The current paper explicated on those findings by proposing ‘commitment to continue’ as a possible underlying condition, which could determine whether safety behaviors have harmful or helpful effects. Method: The Van den Hout et al. (2011) study was replicated with 48 participants. As an additional variable, high or low commitment was implemented by means of verbal emphasis as well as the signing of a contract. A group undergoing exposure with response prevention was added. Results: For contamination, safety behavior plus commitment was superior to mere exposure. Safety behaviors without commitment fell in between. The effects were mainly due to a fast drop for safety behavior plus commitment in the beginning. Towards the end of the trials, groups dropped alike. Significant effects, but no group differences, were found for fear, danger and disgust. Limitations: Findings were obtained from a non-clinical sample and no double blind was used. Conclusion: This study was able to confirm the previous finding that safety behaviors are not always harmful, and may even have beneficial effects. Commitment seems to have an influence, at least for contamination, but the hypothesis that commitment is the determining factor for harmfulness vs. helpfulness of SB's could not be sustained. Clearly, more research in this area is needed.